Extreme nursing: a qualitative assessment of nurse retention in a remote setting.

INTRODUCTION Nurses have practiced in Bristol Bay, Alaska, since 1896. Practice opportunities are defined by institutional structures and systems; and the geography, climate, and history of remote South-west 'bush' Alaska. The Native Alaskan culture as experienced through nurses' practice, community relations, and in several cases, marriages, shapes their lives as well. The purposes of this qualitative study are three-fold: (1) to ensure the unique stories of bush Alaska nurses are preserved and told; (2) to foster a strong bush nursing tradition; and (3) to inform recruitment, hiring, and retention practices in remote settings. METHODS Ten of 14 long-term retained (>15 years) nurses still living in Bristol Bay were interviewed using a semi-structured format, based on three broad interview questions: (1) Why did you come to Bristol Bay?; (2) If you ever wanted to leave, what motivated you to stay?; and (3) What do you feel are your greatest accomplishments here? Extensive probing and dialogue was employed to develop participants' conversation. Interviews were recorded, transcribed and coded for qualitative content analysis of ideas and thematic analysis. To preserve authenticity and enhance fidelity, nurses' verbatim statements are reported at length, illustrating ideas and themes. RESULTS Analysis of transcripts revealed seven ideas common to all 10 long-term retained nurse's experience in the bush: family, culture, hardship, nursing practice, fish, motivations and community. Religion or spirituality was also a common idea, but not universal. A racism code was derived to illuminate less articulated ideas from the nurses' conversation. CONCLUSIONS Long-term retained bush nurses share three characteristics useful to successful recruitment and retention efforts: they have (1) a strong sense of adventure, (2) an independent outlook regarding family growth and development, and (3) a deep appreciation of Native Alaskan culture and lifestyle. In summary they advise nurses who wish to practice and stay in the bush to come with 'ample resources, mental resources, emotional, spiritual, the whole nine yards, [they] need these resources in order to survive, in order to stay here. [Also] a love for the people, not being opposite to the culture but trying to learn [from it]'. Attributes and qualities nurses bring to remote South-west bush Alaska produce a community dynamic affecting practice, health, and quality of life.